Many children with chronic heart disease subsequent to undetected rheumatic fever are brought to the physician.1 While the acute phases and the numerous manifestations of this condition have been repeatedly studied,2 the end-results of the cardiac damage have received less attention. The prevalent view that heart muscle failure in childhood is similar to that found in adults is misleading.3 The manner in which the child's heart affected by cardiovalvular disease fails must be carefully understood before therapy adequate to prevent further progress of the damage can be instituted.
In an analysis of the case histories of 185 children under 15 years of age admitted to the Montefiore Hospital and found to be suffering with chronic rheumatic endocarditis, there were 100 who showed signs of heart failure. The time spent by these children in this institution varied from one month to five years. Since the average period of